Rare disorder explains JFK's health woes

New research points to an autoimmune endocrine disorder as the cause of at least some of President John F. Kennedy's health problems.

Despite his relative youth -- at 43, Kennedy remains the youngest person elected president -- and his seeming vigor, Kennedy "had the most complex health history of anyone to occupy the White House," said Lee R. Mandel, MD, MPH, senior medical officer of the aircraft carrier USS George H.W. Bush and a historian interested in presidential medicine. His findings were published in the Sept. 1 Annals of Internal Medicine (link).

For his study, Dr. Mandel combined evidence gleaned from his review of Kennedy's medical records at the John F. Kennedy Presidential Library and Museum in Boston, with material obtained from additional sleuthing. Kennedy's complex medical history has received much scrutiny since his medical records were made public in 2002.

Dr. Mandel found mentions of Kennedy being diagnosed with hypothyroidism and Addison's disease.

"The fact that Kennedy, who unequivocally had Addison's disease, also had hypothyroidism leads to the plausible conclusion that there was an autoimmune basis for his medical problems, and APS 2 [autoimmune polyendocrine syndrome type 2] explains these conditions," Dr. Mandel wrote.

"I saw the common thread that other people had commented on casually," he said in an interview. "I think he did have an autoimmune syndrome."

Autoimmune thyroid disease coexists with Addison's disease in two-thirds of cases. APS 2 typically occurs in early adulthood, at around age 30, the age Kennedy was when Addison's disease was diagnosed, Dr. Mandel said.

Autoimmune syndromes are often found in families, he added. "[Kennedy's] sister Eunice [Kennedy Shriver], who just passed away, was believed to have Addison's disease and his son, John F. Kennedy Jr., had Graves' disease."

Kennedy also had intestinal ailments likely caused by undiagnosed celiac disease, Dr. Mandel said.

In an era when media scrutiny is less intense than today, Kennedy and his physicians were able to conceal many of his health problems or attribute them to heroic activities. For example, back pain stemming from his degenerative condition was instead attributed to a war injury. Symptoms from his Addison's disease were described as a recurrence of malaria contracted in World War II.

But even if he were running for election today rather than in 1960, Kennedy's Addison's disease would likely not prove an obstacle. Even without modern advances, Kennedy's disease was well-controlled, Dr. Mandel said. He attributed that feat to Kennedy's endocrinologist, Eugene Cohen, MD, "the brains behind the management of the disease."